Provider Demographics
NPI:1326081472
Name:PEREZ, MARLENE YARITZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:YARITZA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G22 CALLE MONTE ALEGRE
Mailing Address - Street 2:URB. LOMAS DE CAROLINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-8015
Mailing Address - Country:US
Mailing Address - Phone:787-762-1444
Mailing Address - Fax:
Practice Address - Street 1:G22 CALLE MONTE ALEGRE
Practice Address - Street 2:URB. LOMAS DE CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-8015
Practice Address - Country:US
Practice Address - Phone:787-762-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI 48068Medicare UPIN
PR23598Medicare ID - Type UnspecifiedNUMERO PROVEDOR MEDICARE